Sangomas, Inyangas and Traditional Health Practitioners in South Africa: Roles and Regulation

Who they are

In South Africa, "traditional health practitioner" (THP) is the legal term for people who practice traditional healing. [1] In everyday speech and in research you will meet more specific names. A sangoma is described by a Stellenbosch University reference as a Nguni word for a diviner, and an inyanga as a herbalist and traditional healer. [2] A South African English dictionary gives "a traditional healer or diviner, especially one specializing in herbalism" for inyanga and notes that the term is applied mainly to Zulu traditional healers. [3] A published interview study of ten practitioners in KwaZulu-Natal included sangomas, inyangas and umthandazi. [4] The roles can overlap, and individual healers describe their own work differently. This page uses the terms as the sources do and does not describe ceremonies.

How people become healers

Researchers who interviewed 18 traditional health practitioners in Johannesburg in 2022 report that becoming a healer was almost always preceded by an illness with dreams or visions understood as an "ancestral calling." [5] Most of them had trained as both sangomas, who heal according to traditional beliefs, and prophets, who heal according to Christian beliefs. [5] An author who trained as a sangoma says the knowledge is passed on orally, differs from healer to healer, and that some of it is secret and cannot be revealed. [6] Out of respect, this site does not describe initiation, ceremonies or sacred practices. Those belong to the communities and healers concerned.

What the ancestors and calling mean (as a traditional framework)

Many sub-Saharan peoples hold that ancestors can guide events and are revered for that power, according to the same healer-author. [6] This is a spiritual and cultural framework. It is not a biomedical mechanism, and drug-style trials do not test it. Researchers who spoke with six South African healers found they understood suicidal behavior as a symptom of social disconnection and cultural discontinuity, and reported helping people by reconnecting them with family, ancestors and cultural identity. [7] Those are the healers' own accounts, not measured outcomes.

The law: Traditional Health Practitioners Act 22 of 2007

South Africa's Act, as published on the government's own site, has these main features:

• Purpose: to set up an Interim Traditional Health Practitioners Council, provide for the registration, training and practice of practitioners, and protect people who use their services. [1]
• Categories: the Act defines registered diviners, herbalists, traditional birth attendants and traditional surgeons, plus traditional tutors who teach. [1]
• Definition: it defines "traditional philosophy" as indigenous African techniques, principles, theories, beliefs and customs passed from ancestors to descendants, with or without written documentation, "whether supported by science or not." [1]
• Scope: traditional health practice does not include the work of professions under the Health Professions, Nursing, Pharmacy and similar Acts, and "traditional medicine" excludes dependence-producing or dangerous substances. [1]
• Unregistered practice: the Act says no payment is recoverable for acts that a person not authorised under the Act performs for gain. [1]

A 2016 article in the South African Medical Journal describes implementation: the Act was promulgated, an interim council and a registrar were being put in place, and the aim was formalization and cooperation with biomedical providers. [8] I could not read the Council's own website this session, so I cannot say how many practitioners are registered today or which parts of the Act are currently in force. Check the Council and the national Department of Health directly.

What research shows about their role

• Use: in a national survey (2002 to 2004) 9% of South African adults consulted a traditional healer, more often if older, unemployed, with less education or with an anxiety or substance-use disorder. [9]
• Medical pluralism: many practitioners blend Western and traditional treatments, which the authors say may make collaborative services acceptable. [5]
• Delay in tuberculosis care: in a small rural study, people who saw a healer first waited longer to start tuberculosis treatment and more of them died (31% vs 12%). This is observational, so it shows an association, not proof of cause. [10]
• Collaboration: studies of healers in South Africa conclude that knowledge exchange can support safer care and collaboration. [4] See traditional healers and modern health systems.

There is no evidence in these sources that divination itself diagnoses or treats a medical disease; research has looked at use, beliefs and referral, not at divination outcomes. Evidence for specific herbs is on their own pages, such as African potato.

Safety, medicines and herbs

Herbal remedies can interact with prescribed medicines, and most evidence on this is from lab studies. [11] Tell your clinician and pharmacist about everything you use, and never stop prescribed medicines (for example HIV or tuberculosis treatment) on anyone's advice without your clinician. See African herbs and HIV or AIDS claims and traditional medicine safety.

Mental health and urgent help

If you or someone you know is thinking of suicide, get help right away. In the US call or text 988 or call 911. Outside the US use your local emergency number or nearest clinic or hospital. Many people consult both a healer and a clinician; telling each about the other helps.

How to check a practitioner (no list is given here)

This site does not list or recommend practitioners. To check one:

• Ask whether they are registered under the Traditional Health Practitioners Act and in which category, and ask to see proof. Registration is a legal status, not a guarantee of skill.
• Ask how they handle illnesses that need tests or hospital care, and whether they will refer you.
• Ask about any product you are given: what it is, whether it is registered, and what it may interact with.
• Be wary of anyone who promises cures, tells you to stop medicines, or pressures you to pay. See choosing a qualified practitioner.

Related pages

African traditional medicine overview, traditional birth attendants and bone setters, and Indigenous and community traditions.